Blood Tests Predict Lung Damage in 9/11 Firefighters.

Dietary changes could prevent future health problems, study says.

Seventeen years since the 9/11 attacks on the World Trade Center, rescue workers and survivors are still feeling the health effects of exposure to the dust and smoke produced by the collapsing twin towers. But a new study may help medical experts understand why some people have gotten sick and others have not. The study, published September 4, 2018, in the journal BMJ Open Respiratory Research, has found that certain metabolites in the blood can help determine which firefighters are most likely to develop lung problems, so that appropriate treatment can be started. “This study allowed us to identify molecules in the blood that are predictive of who will eventually lose lung function,” says Anna Nolan, MD, senior research investigator and associate professor in the department of medicine at NYU Langone Health in New York City. “What makes the study important is that you can potentially alter these molecules by changing someone’s diet, and hopefully affect a change in that person’s outcome.”

Abnormal Metabolites Point to Future Troubles

Along with co-investigators George Crowley and Sophia Kwon, DO, MPH, Dr. Nolan analyzed data from 30 nonsmoking male firefighters who had blood samples taken within 200 days after their exposure at Ground Zero. Half the participants had a significant loss in lung function by 2015, while the other half had healthy lung function. Lung function was evaluated by forced expiratory volume, a common test for measuring how much air a person can exhale during a forced breath. Researchers observed that those with lung damage had abnormal levels of more than two dozen metabolites. Metabolites are chemicals produced in the body as it breaks down fats, proteins, and carbohydrates. Investigators highlighted the following changes in chemical groups as being highly predictive of lung injury and obstructive airway disease (OAD):

Decreases in sphingolipids, such as sphingosine 1-phosphate, a fat previously been linked to higher rates of asthma and inflammation.

Declines in branched-chain amino acids, the building blocks of proteins, including leucine and valine, whose supplementation has in previous research been shown to counter chronic obstructive pulmonary disease (COPD).

Increases in levels of stress hormones, especially vanillylmandelate, which may lead to elevated levels of fatty acids, potentially inducing inflammation

Mediterranean Diet May Help.

A low-calorie Mediterranean diet (predominantly fish- and olive oil-based, with limited red meat) has been shown to rebalance metabolites. Nolan noted that other studies have found that people with emphysema and COPD have benefited from similar diets. The researchers’ next step is to measure the effects of a Mediterranean diet on the firefighters who have loss of lung function. They hope to start a trial in the next month or two.

Potential for Diagnosis on a Bigger Scale

Analysis of metabolite blood tests could aid in the diagnosis and treatment of the roughly 9,000 firefighters exposed to toxic chemicals at the World Trade Center, according to the study’s authors. Nolan says that prior research has found that about 1 in 10 of these firefighters exhibited signs of lung damage. Nolan also wants to validate results from this small investigation with a much larger population. She sees the potential of this type of testing helping a broader population of those who were exposed to toxins in the attacks. In an article on the website SurvivorNet, Gaetane Michaud, MD, chief of interventional pulmonology with NYU Langone Health and its Perlmutter Cancer Center, highlighted how widespread 9/11-related health problems may be. Dr. Michaud says that about 300,000 people exposed to toxic air may be at risk of developing cancer. The Centers for Disease Control and Prevention (CDC) estimates that about 400,000 people were exposed to toxins, such asbestos, lead, and benzene, when they were released into the air.

“The ultimate goal [from our research] is to put together a comprehensive profile, including various types of biomarkers, in order to pinpoint who is most at risk and potentially who would benefit from some treatment modalities,” says Nolan.